Client Consent Form

I hereby acknowledge that Therapy Pro has advised
me of the following:

Why Therapy Pro collect my information.

What happens to my information, how it is used and how it is stored

My right to access my personal information.

My right to withdraw my consent at any time.

Authorisation*

I am aware of, understand that, and give my permission that Therapy Pro may collect and disclose my personal information to third parties (as required) so that I receive a quality service that meets my needs

I nominate that my personal information only be disclosed to the following person/s or agencies listed here:

Authorised person/s or agencies

Acknowledgements*

I understand Therapy Pro must comply with Federal Privacy Act 1988 and relevant State government privacy laws, and the circumstances under which my information needs to be provided for legal and safety reasons, has been explained to me by the therapist.

I will contact Therapy Pro immediately if I feel that my privacy has been breached.